Abstract
Objectives
In acute care settings, interactions between providers and tools drive clinical decision-making. Most studies of decision-making focus on individual cognition and fail to capture critical collaborations. Distributed Cognition (DCog) theory provides a framework for examining the dispersal of tasks among agents and artifacts, enhancing the investigation of decision-making and error.
Content
This scoping review maps the evidence collected in empiric studies applying DCog to clinical decision-making in acute care settings and identifies gaps in the existing literature.
Summary and outlook
Thirty-seven articles were included. The majority (n=30) used qualitative methods (observations, interviews, artifact analysis) to examine the work of physicians (n=28), nurses (n=27), residents (n=16), and advanced practice providers (n=12) in intensive care units (n=18), operating rooms (n=7), inpatient units (n=7) and emergency departments (n=5). Information flow (n=30) and task coordination (n=30) were the most frequently investigated elements of DCog. Provider-artifact (n=35) and provider-provider (n=30) interactions were most explored. Electronic (n=18) and paper (n=15) medical records were frequently described artifacts. Seven prominent themes were identified. DCog is an underutilized framework for examining how information is obtained, represented, and transmitted through complex clinical systems. DCog offers mechanisms for exploring how technologies, like EMRs, and workspaces can help or hinder clinical decision-making.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. EW and MD contributed equally to this paper. EW, MD, and CS conceptualized the review and generated the research question. EW, MD, and WT designed and iteratively refined the database search algorithms. EW, MD, and AR completed title/abstract and full text screening. EW, MD, AR, DT, SD, CA, CS completed data extraction and analysis. EW, MD, AR, and NG conducted the thematic analysis. EW and MD generated all figures and tables. EW, MD, and CS wrote the manuscript. All authors read, edited, and approved the manuscript.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Not applicable.
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Ethical approval: Not applicable.
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The online version of this article offers supplementary material (https://doi.org/10.1515/dx-2022-0095).
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